The Importance of Continued and Ongoing Auditing

While it seems initial coding audits have become a common practice among healthcare organizations, the importance of continued and ongoing auditing has become lost and forgotten. Keeping up with ongoing auditing is crucial for any healthcare organization as this can prevent revenue from being lost and the amount of unwanted and unnecessary denials from increasing. This also gives healthcare organizations a chance to educate their coding specialists and identify if their coding qualities align with their organization’s quality standards. Missed physician queries can also play a key role in the importance of ongoing auditing. Many organizations struggle with ongoing auditing whether it be because they are already overwhelmed with everyday tasks, they are unsure of how to implement this on an ongoing basis, or because this can be seen as a costly expense. These common problems can lead to monitoring of coding quality falling through the cracks. 

LET’S TALK ABOUT COST.

Whether you look to accomplish this internally or externally, one of the challenges that healthcare organizations can face is cost. Many healthcare organizations can’t afford costly programs, so it’s important to find a program that works for them; one that is able to perform ongoing auditing, but also is in their organization’s budget. While this can be seen as an additional expense, what healthcare organizations can gain by implementing ongoing auditing will outweigh the cost. Whether this cost means you are looking internally or needing to hire on additional staff externally, the recovery of lost revenue from improper billing can be significant and it will also reduce the amount of denials that many organizations deem as an issue and are looking for ways to prevent. 

ARE YOUR CODING SPECIALISTS PROPERLY EDUCATED?

Another important reason for performing ongoing auditing is making sure coding specialists are up to date on the constant changes within the healthcare industry. Ongoing audits can help identify any problems or areas where a coding specialist is needing more training and education. This can also uncover coding error trends that multiple coding specialists may be struggling with. By making sure coding specialists are properly educated, this will ensure accurate code assignments and APR/DRGs which will then lead to proper billing and payments and reduction of denials.

MISSED QUERY OPPORTUNITY?

Performing ongoing coding audits is also a great way to uncover missed opportunities for the coding specialist to query the physician when documentation is vague, questionable, or unclear. By sending physicians a proper query, this can lead to not only educating the physician on what we are querying, but why we are querying. Many times, the physician doesn’t realize by making the code more specific it can impact payment. This can be done by changing an unspecified diagnosis code to the proper specific code, which can then lead to making that code a CC or MCC, which may then change the DRG and the payment. This is not the scenario in every case, but many times making that change can help recover lost revenue. By educating the physicians on the importance of documentation improvement, this will prevent the coding specialists from having to send future queries and will help cut down on unnecessary workload and stress for both the coding specialist and the physician.

NEED HELP?

If your healthcare organization is struggling with finding a solution on ways to implement ongoing auditing, Elevate Medical Solutions can help! To learn more on how we can assist you, please feel free to contact us.